Coroner for south Mayo John O’Dwyer commented this week that patients in Mayo who have a heart attack may not have the best opportunity for survival given the short time frame they have to get to the cardiac unit at University Hospital Galway.
Mr O’Dwyer made his comments during an inquest hearing on Thursday in Castlebar. The inquest related to the death of Mr Eneas McDonnell (74 ) Erriff, Leenane, Co Galway, after he had a heart attack at Mayo General Hospital on August 17 2012.
Mr McDonnell was brought to Mayo General Hospital that evening by his neighbour as he had a pain in his left shoulder, found it hard to catch his breath, and was weak. He presented to the nurse at the hospital at 8.35pm. He was examined immediately and an ECG showed that he was having a heart attack and he was transferred to the resuscitation room. Medical registrar on call, Dr Rizvi, contacted a registrar at the cardiac specialist centre in University Hospital Galway, as there is no cardiac centre in Mayo. He was advised that Mr McDonnell should be transferred immediately to Galway University Hospital. Ambulance control was contacted by a clinical nurse manager at 9.05pm, who was told that no ambulance would be available until 11pm. There were two ambulance crews outside Mayo General Hospital, however the clinical nurse manager was informed that they were “not clear” and could not be used.
The doctor informed cardiac staff that there was no availability of an ambulance and as he would not make Galway within a 90 minute timeframe the doctor was advised to thrombolyse the patient (administer a clot busting drug ) and then transfer the patient when an ambulance was available. A private ambulance had been called and was on the way. Mr McDonnell was thromboloysised at 9.30pm. At 9.40pm Mr McDonnell suffered a cardiac arrest. Resuscitation was carried out, however Mr McDonnell was pronounced dead at 10.20pm.
Ambulance was not dispatched
The inquest highlighted that an error had been made by the National Ambulance Service as the emergency medical controller based in Castlebar who took the call from Mayo General Hospital did not categorise the call as an emergency even though the nurse manager said that it was an emergency. However she did not use the new protocol trigger word (CODE STEMI ) which would have directed an ambulance to go straight to the hospital. This new protocol was only in place since July of that year.
The nurse manager called back a few minutes later, again to again ask for an ambulance. Another call-taker answered and she was transferred to an ambulance dispatcher. At 9.23pm the dispatcher told the nurse manager that an ambulance was on the way, however he was informed that the patient was having a drug administered and a private ambulance was on the way.Coroner Mr O’Dwyer asked the call-taker where the ambulance would have come from if the “magic words” were used initially to which he was told that there was an ambulance available that night in the Castlebar base for CODE STEMI calls.
Paudie O’Riordan, area operations manager for the National Ambulance Service West admitted that an error was made as an ambulance should have been dispatched immediately but this was not done. Mr O’Riordan said that an internal review has been carried out and he explained that since this incident that all such transfers from hospitals are treated as an emergency and six STEMIS have occurred since this incident and have all followed protocol.
In recording his verdict of death by natural causes — due to the pathologist’s report which stated that Mr McDonnell had a major blockage of his artery — Mr O’Dwyer said that Mayo General staff did everything they could to deal with the situation promptly. He said that it was regrettable that an ambulance could not have been made available sooner. He commented: “What I find unnerving is the level of support available for patients in an emergency situation.” He said that it is “physically impossible”, “totally unrealistic and unachievable” to get a cardiac patient to Galway from Mayo, particularity in rural areas, in 90 minutes. He said that patients of Mayo “are not getting the opportunity of survival” that they should get, and are not getting the “best possible service” which they are entitled to.
Mr O’Dwyer said that it must be brought to the attention of the Taoiseach that “people of this county are being deprived of the best opportunity of surviving a cardiac arrest.”
Mr O’Dwyer said that an air ambulance should be used where possible and there should be a cath lab in Mayo General where a staff member can perform an angiogram.